The Novel Hemodynamic Variable Aortic Pulsatility Index Predicts Freedom from Advanced Heart Failure Therapies and Death

Abstract

We hypothesized that a novel invasive hemodynamic measure reflecting cardiac contractility and filling pressure would predict long-term prognosis. We retrospectively analyzed consecutive patients undergoing right heart catheterization (RHC) with milrinone drug study at our institution between 2/2013-2/2017. In addition to usual RHC measurements aortic pulsatility index (API) was calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure. Univariate and multivariate logistic regression analyses were conducted to determine association with continued medical management (MM) compared to advanced therapies (AT), defined as the combined endpoint of progression to left ventricular assist device, orthotopic heart transplant or need for inotropes, or death at 30 days and 1 year. A total of 120 patients (33% female, average age 57 ± 13 years, 45% ischemic cardiomyopathy) were included in the analysis. Baseline API was higher in patients on MM at 30-days and 1-year post-RHC, OR 2.6 (95% CI 1.6-4.5,p<0.001), OR 3.1 (95% CI 1.7-5.6,p<0.001), respectively, compared to those that progressed to AT or death. In univariate analysis a 1-point increase in API was associated with increased odds of MM compared to progression to AT or death, OR 2.6 (95% CI 1.6-4.5,p<0.001), OR 3.1 (95% CI 1.7-5.6,p<0.001) at 30-day and 1-year follow-up, respectively. In multivariate analysis API was strongly associated with continued MM and freedom from AT or death when adjusted for Fick cardiac index and pulmonary artery pulsatility index at 30-days and 1-year, respectively, OR 2.4 (95% CI 1.3-4.3, p=0.004), OR 3.2 (95% CI 1.5-6.6,p=0.002). Change in API after milrinone infusion was not significantly associated with MM at 30-day or 1-year follow-up. API is a novel invasive hemodynamic measurement that better predicts freedom from AT or death at 30-day and 1-year follow-up when compared to traditional RHC measurements.